| NPI | 1063512242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.30200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL29154) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2015-07-14 |